Topic Contents

Mastitis While Breast-Feeding

Topic Overview

What is mastitis?

Mastitis is a breast inflammation usually caused by
infection. It can happen to any woman, although mastitis is most common during
the first 6 months of
breast-feeding. It can leave a new mother feeling very
tired and run-down. Add the illness to the demands of taking care of a newborn,
and many women quit breast-feeding altogether. But you can continue to nurse
your baby. In fact, breast-feeding usually helps to clear up infection, and
nursing will not harm your baby.

Although mastitis can be discouraging and painful, it is usually easily
cleared up with medicine.

What causes mastitis?

Mastitis most often happens
when bacteria enter the breast through the nipple.
This can happen when a nursing mother has a cracked or sore nipple.

Going for long stretches between nursing or failing to empty the breast
completely may also contribute to mastitis. Using different
breast-feeding techniques and making sure your baby is
latched on properly when nursing will help with emptying the breast and avoiding
cracked nipples.
View a slideshow on latching to learn how to get your baby to latch on.

What are the symptoms?

Mastitis usually starts as
a painful area in one breast. It may be red or warm to the touch, or both. You
may also have fever, chills, and body aches.

Signs that mastitis
is getting worse include swollen, painful
lymph nodes in the armpit next to the infected breast,
a fast heart rate, and flu-like symptoms that get worse. Mastitis can lead to a
breast
abscess, which feels like a hard, painful lump.

What increases your risk of getting mastitis?

You
are more likely to get mastitis while breast-feeding if:

You have had mastitis before.

You delay or skip breast-feeding or pumping
sessions. When you don't empty the breast regularly or completely, your breasts
become
engorged or too full, which can lead to mastitis.

You have cracked or irritated nipples, which can be caused by poor
positioning or poor latching on.

You have
anemia. Anemia makes you tire more easily and lowers
your resistance to infections like mastitis.

Breast-feeding mothers can get mastitis at any time, but
especially during the baby's first 2 months. After 2 months, the baby's feeding
patterns become more regular, which helps prevent mastitis.

How is mastitis diagnosed?

Your doctor can tell
whether you have mastitis by talking with you about your symptoms and examining you. Testing is usually not needed.

How is it treated?

Antibiotics can
usually cure mastitis. If your doctor prescribes antibiotics, take them as
directed. Do not stop taking them just because you feel better. You need to
take the full course of pills. The antibiotics will not harm the baby. If
treatment doesn't work at first, your doctor may send a sample of your breast
milk to a lab to help identify the type of bacteria causing the infection.

You can help yourself feel better by getting more rest, drinking
more fluids, and using warm or cold packs on your painful breast.

Before breast-feeding your baby, place a warm, wet washcloth over the
affected breast for about 15 minutes. Try this at least 3 times a day. This
increases milk flow in the breast. Massaging the affected breast may also
increase milk flow.

You can safely take acetaminophen (such as
Tylenol) for pain or a fever. You can take ibuprofen (such as Advil) along with
acetaminophen to reduce inflammation. Be safe with medicines. Read and follow all instructions on the label.

Breast-feeding from your
affected breast is safe for your baby. If starting with the affected breast is too painful, try feeding your baby with your healthy breast first. Then, after your milk is flowing, breast-feed from the affected breast. If your nipples are too cracked and painful to
breast-feed from that breast, hand express or use a breast pump to empty the breast of milk.
Try this each time that you cannot breast-feed.

This is a good time
to consider getting help from a
lactation consultant. This person-usually a
nurse-specializes in helping women with breast-feeding. You can breast-feed
more effectively with less pain and help prevent future mastitis if you
remember to change positions and make sure that your baby is latching on
properly.

Be sure to get treatment for mastitis. Delaying
treatment can lead to a breast abscess, which can be harder to treat.

Call your doctor if you have other breast problems like cracked and bleeding nipples or blisters on your nipples that are not relieved by home treatment.

Breast abscess

In some cases, symptoms of mastitis
get worse and the breast develops a pocket of pus (abscess) in the
infected area. Symptoms of a breast abscess include:

A breast lump that is hard and
painful.

A reddened area on the breast.

Flu-like
symptoms that are getting worse.

Thrush infection

Thrush (yeast infection) can occur in your baby's
mouth and spread to your nipples and breast ducts. If you have symptoms of
mastitis that are not going away in spite of treatment, pain in the nipple area
during and after breast-feeding, sharp breast pain in between feedings, or
nipples that look very pink, you may have a yeast infection. This condition can also begin
with a sudden start of pain or burning when breast-feeding has been going well
without problems.

If you have yeast infection symptoms, both your nipples
and your baby's mouth should be checked for thrush. Treatment for thrush
requires that both you and your baby be treated, even if your baby doesn't have
symptoms. For more information, see the topic
Thrush.

Exams and Tests

Your doctor can usually diagnose
mastitis based on your symptoms and an examination of
the affected breast. Tests are usually not needed. But
they may be done to confirm a diagnosis or to help guide treatment for other
problems that can develop.

Breast milk culture

If you have an infection that
isn't improving with treatment, your doctor may do a breast milk
culture. To provide a sample for a culture, you will
squeeze a small sample of milk from the affected breast onto a sterile swab.
The culture results help your doctor confirm a diagnosis and to find out the
specific bacteria that are causing the infection.

In some cases, it
takes more than one round of antibiotics to clear a breast infection. If you
have not been responding to antibiotic treatment, culture results may be used
to find out the most effective antibiotic for you.

Abscess

Sometimes a pocket of pus (abscess) forms
in the reddened area of the breast. If an abscess is too deep to examine by
touching it, your doctor may use a
breast ultrasound to examine it. Ultrasound can also
be used to guide a needle to an abscess that needs to be drained of fluid. A
culture of the abscess fluid is usually done to identify the infecting
organism.

Treatment Overview

Mastitis will
not go away without treatment. If you have
mastitis symptoms, you may need to call your doctor
today. Prompt treatment helps keep infection from rapidly getting worse and
usually improves symptoms after about 2 days.

Mastitis treatment

Regularly emptying the breast well by breast-feeding or
pumping breast milk. Adequate emptying of the affected breast helps prevent
more bacteria from collecting in the breast and may shorten the duration of the
infection.

You can safely continue breast-feeding your baby or
pumping breast milk to feed your baby during illness and treatment. Your baby is the most efficient pump you have for emptying
your breasts. Your breast milk is safe for your baby to drink, because any
bacteria in your milk will be destroyed by the baby's digestive juices.

Before breast-feeding your baby, place a
warm, wet washcloth over the affected breast for about 15 minutes. Try this at
least 3 times a day. This increases milk flow in the breast. Massaging the
affected breast may also increase milk flow.

If possible, continue breast-feeding on both sides. Ideally,
start on the affected side-it's critical that you empty this breast thoroughly. If starting with the affected breast is too painful, try feeding your baby with your healthy breast first. Then, after your milk is flowing, breast-feed from the affected
breast until it feels soft. Switch back to the healthy breast and breast-feed
until your baby has finished.

Pump or express milk from the
affected breast if pain prevents you from breast-feeding. Nipple pain can be
caused by the baby latching on to sore nipples. For more information on pumping
or expressing breast milk, see the topic
Breast-Feeding.

Your baby may seem
reluctant to nurse on your painful breast. This is not because your milk tastes
strange, but more likely because your breast feels different and it is harder
for your baby to nurse. Try expressing a little milk first. This will soften
the breast and make it easier for your baby to latch on.

Breast abscess treatment

If you have mastitis
because of a blocked duct and you delay treatment, your breast infection may
develop into an
abscess. Treatment for an abscess includes:

Emptying the breast well and regularly by breast-feeding or
pumping, which is essential to keeping a good milk supply.

Most women can continue breast-feeding on the affected
breast while an abscess heals. With your doctor's approval, you can cover the
abscess area with a light gauze dressing while breast-feeding.

If
you are advised to stop breast-feeding from the affected breast while an
abscess heals, you can continue breast-feeding from the healthy breast. Be sure
to pump or express milk from the infected breast regularly.

For
more information on pumping or expressing breast milk, see the topic
Breast-Feeding.

Home Treatment

From the time you begin breast-feeding
until your baby is weaned, take measures to
prevent mastitis. For example, learn about
different breast-feeding techniques so that you will
know how to completely empty your breasts. Not emptying your breasts completely
when nursing or going too long between feedings may lead to mastitis. View a slideshow on latching to learn how to get your baby to latch on.

If you have
symptoms of mastitis, you may need to call your doctor
right away. Delaying treatment can lead to an
abscess forming in the affected breast. Severe
infection can require
intravenous antibiotics in the hospital.

Breast-feeding with mastitis

Along with oral
antibiotic treatment, continuing to nurse your baby and being careful to empty
your breasts completely will help shorten the duration of the infection.

You can safely continue breast-feeding your baby or pumping
breast milk to feed your baby during illness and treatment. Your baby is the most efficient pump you have for emptying
your breasts. Your breast milk is safe for your baby to drink, because any
bacteria in your milk will be destroyed by the baby's digestive juices.

Before breast-feeding your baby, place a
warm, wet washcloth over the affected breast for about 15 minutes. Try this at
least 3 times a day. This increases milk flow in the breast. Massaging the
affected breast may also increase milk flow.

If possible, continue breast-feeding on both sides. Ideally,
start on the affected side-it's critical that you empty this breast thoroughly.
If starting with the affected breast is too painful, try feeding your baby with your healthy breast first. Then, after your milk is flowing, breast-feed from the affected
breast until it feels soft. Switch back to the healthy breast and breast-feed
until your baby has finished.

Pump or express milk from the
affected breast if pain prevents you from breast-feeding. Nipple pain can be
caused by the baby latching on to sore nipples. For more information on pumping
or expressing breast milk, see the topic
Breast-Feeding.

A lanolin-based cream,
such as Lansinoh, may help heal sore or cracked nipples.

If you
use nursing pads, replace them frequently so they are dry and clean.

Self-care measures for mastitis

In addition to
taking your prescribed antibiotics and continuing to breast-feed or pump breast
milk, there are other steps you can take to make yourself feel better until the
mastitis goes away.

Take
acetaminophen (such as Tylenol) to relieve your pain, fever,
or discomfort. You can take
ibuprofen (such as Advil) along with acetaminophen to
reduce inflammation if needed. Be safe with medicines. Read and follow all instructions on the label.

Rest as much as
possible.

Apply an ice pack or a warm compress to the affected
breast to help reduce your pain. If you use an ice pack, place the ice outside
of your bra or clothing. Do not put the ice directly on your bare
skin.

Drink extra fluids.

If your breasts are very full
(engorged), pump or express a small amount of breast
milk before breast-feeding. This will make your breasts less full and may make
it easier for your baby to latch on to your breast.

If pus is
draining from your infected breast, wash the nipple gently and let it air dry
before putting your bra back on. A disposable breast pad placed in the bra cup
may absorb the drainage.

Most women can successfully continue breast-feeding
during a breast infection. If mastitis makes it difficult for you to continue
breast-feeding while the infection is being treated, remember that emptying
your breasts regularly is essential. Don't hesitate to talk to your doctor or a
lactation consultant for further help and
support.

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